Friday, 1 November 2013

When it comes to
dispensing Specials, pharmacists are as likely to refer to CCG (PCT) advice as
to their own RPS Guidelines on best practice.This is clear evidence of the continued and increasing pressure by CCGs
(PCTs) to focus on cost, even though the overall Specials bill has decreased by
25%1 since the introduction of the Specials Tariff in November 2011.

A survey
conducted by the Association of Pharmaceutical Specials Manufacturers in June
2013 explored the attitudes of 200 pharmacists into various aspects of the Specials
sector and compared the results with a similar survey conducted in 2012.

A year ago,
pharmacists were most likely to refer to a GP for advice about a Specials
prescription (49.5%).However, in 2013
pharmacists ranked CCGs (PCTs) their first source of advice (52.5%) - a
significant increase from 46.5% in the previous year.The poll of pharmacists went on to state that
50% had been asked to monitor or reduce their specials dispensing (compared
with 42% in 2012) and 24% said they had been asked to reduce their spend on Specials
(compared with 13% in 2012).

The concern is
that pressure from CCGs (PCTs) could eventually compromise quality, says the
APSM.There are already signs that this
could be happening, for example, a corresponding survey of GPs showed an
increase in doctors prepared to offer a tablet with instructions to crush or
split (64% in 2013 compared with 55% in 2012). The survey showed that GPs are
under similar pressure to cut cost – more than half indicated that they have
been asked by their CCG (PCT) to reduce spend.

Confidence returning thanks to RPS
Guidelines and Specials Tariff

But the overall
theme of the survey is positive. There
are strong indications of increased confidence in Specials as well as a
measured and informed approach by pharmacists to where, when and how to
dispense.Say the APSM, we believe two
factors have contributed to this, firstly the RPS Guidelines on Specials
Prescribing and secondly the Specials Tariff.These both provide an important framework for making the right choices
about source of supply and cost and this is reflected in our survey results.

For example, 64%
are now more comfortable dispensing Specials since the Tariff was introduced to
regulate prices (45% in 2012).73% think
Specials should be made up by specialist pharmaceutical companies (63.5% in
2012), which reflects the RPS best practice guidelines about hierarchy of risk.

One of the most
encouraging results is the confidence in quality, 72% feel that the quality of Specials
compares with licensed medicines (58% in 2012).This really underlines the fact that we have a very high quality Specials
sector in the UK and one where increased investment over the years has created
an environment where pharmacists feel that they can put patient safety as the
key priority.

However, part of
the fall-out from the increased focus on cost in recent years is that there has
been a potential to lose sight of the patient. For example, although 83% of pharmacists
believe that Specials are essential to meet the special clinical needs of some
patients (an increase from 74% in 2012) the same number have concerns that Specials
are sometimes prescribed unnecessarily.Say
the APSM, “The difficulty with Specials is that they are so unique to the
individual needs of one patient and only their prescribing doctor can make that
decision. As an industry we need to be very careful that these generalisations
don’t impact on individual patients.”

There is a
slight increase in the number of pharmacists who feel that doctors should be
able to prescribe Specials freely according to patient need, 22% (compared with
17% in 2012), but as an industry the Specials sector needs to work hard to
continue to provide information that helps prescribers and dispensers to make
the right judgements in relation to patient need.

Patient need comes first

There is still concern
about cost, but also a significant change in pharmacists understanding of why the
cost of specials reflects patient needs with 41.5% of pharmacists agreeing with
this statement, compared with just 18% a year ago. Says the APSM, “This is because there is far
more transparency around Specials and we need to continue to build on this in
partnership with pharmacists to create an environment where decisions can be
made freely and confidently – and ultimately in the best interest of the
patient.”

Specials account
for less than 1% of all prescriptions, 96% of spend is accounted for by the top
500 specials and of these more than a third are now covered by the Tariff –
with that number increasing withevery
review. Since the introduction of the Tariff, the overall cost of Specials has reduced
by 25% and, according to the APSM survey, confidence in quality and in the
market structure is at an all-time high.